Domain structure of erythrocyte membranes in psoriasis: an EPR study

Proliferating trichilemmal tumour of the eyelid in a 7-year-old girl

Proliferating trichilemmal tumours (PTTs) are rare cutaneous adnexal tumours derived from the hair shaft outer root sheath. We are reporting the first case of PTT in a young child. In this case, a 7-year-old girl presented with trichilemmal keratinisation consistent with PTT. The patient was monitored with no signs of recurrence. PTT is a rare tumour occurring primarily in adults and we present this case so that young patients with PTT can be diagnosed and treated appropriately with a painless, mobile, rapidly growing mass on the right upper eyelid. CT imaging showed well-circumscribed, heterogenous mass measuring 1.6 cm with fluid-filled appearance and no tissue invasion. Surgical excision was performed and pathology revealed an unencapsulated, well-demarcated tumour.

Erythroid disturbances before and after treatment of Portuguese psoriasis vulgaris patients: a cross-sectional and longitudinal study

BACKGROUND

A few studies in psoriasis vulgaris patients have reported changes suggesting red blood cell (RBC) damage is linked to neutrophil activation, oxidative stress, and psoriasis worsening.

OBJECTIVE

The aim of this study was to evaluate erythroid disturbances in Portuguese psoriasis vulgaris patients, before, during, and after treatment.

METHODS

A cross-sectional study (n = 73 patients vs 40 healthy control subjects) followed by a longitudinal study (n = 47 patients) was performed, with assessments before, and at 3, 6, and 12 weeks of therapy (10 patients started topical treatment, 17 narrow-band UVB, and 20 photochemotherapy [psoralen plus UVA; PUVA]). Evaluations included hematologic data, total bilirubin levels, membrane-bound hemoglobin (MBH), membrane protein band 3 profile, total plasma antioxidant status (TAS), lipid peroxidation (thiobarbituric acid [TBA] assay), elastase, lactoferrin, and C-reactive protein (CRP).

RESULTS

Before treatment, patients presented with higher leukocyte/neutrophil and reticulocyte counts, elastase, lactoferrin, TBA, TBA/TAS, reticulocyte production index, total bilirubin and MBH values, lower RBC and hematocrit, higher percentages of high-molecular-weight aggregates, and lower percentages of band 3 monomer. After treatment, we observed a reversal in most of the parameters. However, patients still presented with values suggestive of accelerated RBC damage, removal, and production, as most of the parameters were still higher than those in the control group; the same occurred with CRP.

CONCLUSION

Our data suggest that psoriasis vulgaris triggers an inflammatory response, with release of acute-phase reactants, reactive oxygen species, cationic proteins, and proteases, leading to enhanced RBC damage/aging and, ultimately, to enhanced RBC removal. These assumptions were strengthened by the observation that, with treatment, all of these changes were reversed, the inflammation was reduced, the production of reticulocytes was increased, and the RBCs presented changes usually observed in younger/less damaged RBCs. These erythroid changes were enhanced with PUVA therapy, probably due to the more pronounced clearing of the lesions, as suggested by Psoriasis Area and Severity Index (PASI) scores. Finally, after treatment, a residual inflammation still persisted that might contribute to the observed erythroid disturbances.

Erythrocyte damage in mild and severe psoriasis

BACKGROUND

Psoriasis is a common chronic and recurrent inflammatory skin disorder. Oxygen metabolites and proteases released by activated inflammatory cells may induce oxidative and proteolytic damage to plasma constituents and red blood cells (RBCs). RBCs have a limited biosynthesis capacity and poor repair mechanisms.

OBJECTIVES

To study RBCs as a potential cumulative marker of oxidative and proteolytic stress in psoriasis, and as a marker of worsening of the disease.

METHODS

The study was performed in 70 patients with mild or severe psoriasis and in 40 control individuals. We evaluated total and differential leucocyte count and, as markers of leucocyte activation, plasma elastase and lactoferrin. Besides the basic RBC study (RBC count, haematocrit, haemoglobin concentration and haematimetric indices) we evaluated antioxidant defences (catalase, superoxide dismutase, glutathione peroxidase and selenium), osmotic fragility and reticulocyte count; in the RBC membrane we evaluated lipid peroxidation and susceptibility to lipid peroxidation, membrane fluidity, levels of cholesterol and phospholipids, membrane-bound haemoglobin, band 3 profile and levels of vitamin E; serum levels of bilirubin, total plasma antioxidant capacity, lipid profile and lipid peroxidation were also evaluated.

RESULTS

Psoriasis patients showed a rise in leucocytes, mainly neutrophils, which was associated with a rise in elastase and lactoferrin. Patients had a reduced RBC count, antioxidant defences and membrane fluidity, elevated membrane lipid peroxidation, membrane-bound haemoglobin, osmotic fragility and reticulocyte count, and a different band 3 profile. Most of these modifications were enhanced in severe psoriasis.

CONCLUSIONS

In summary, our data show that the RBCs are at a lower number in psoriasis patients, and present several changes denoting an enhanced damage and/or ageing process, which seem to be strongly connected with neutrophil activation, oxidative stress and worsening of psoriasis.